Eyeworld

N JULY 2019 | EYEWORLD | 21 RESEARCH HIGHLIGHT Contact information Rosen: rrosen@nyee.edu by Maxine Lipner EyeWorld Senior Contributing Writer W hen patients experience eye emergencies after regular office hours, they might not get the same kind of testing they nor- mally would. A recent study 1 considered how an automated OCT machine could impact urgent care in an after-hours clinic. "The problem is that a lot of people come in with conditions of sudden vision loss, and the technology we utilize on a daily basis is much more sophisticated than what's typically available in urgent care," said Richard Rosen, MD, adding that while the New York Eye and Ear Infirmary was one of the first centers to ac- quire daily-use OCT, these devices often require a highly skilled technician. After coming across a robotic OCT system known as the iScan (Optovue), he decided to launch a study on how it might be applied in an after-hours, urgent care setting. iScan uses audio to direct the patient on where to look to line up the scan. It then compares the scan to its database of "normal" images. "When I saw this instrument, I said, 'This is what we need,' because often strokes in OCT after hours About the doctor Richard Rosen, MD Pierce Distinguished Professor of Ophthalmology New York Eye and Ear Infirmary Icahn School of Medicine at Mount Sinai New York Reference 1. Kaplan RI, et al. Impact of auto- mated OCT in a high-volume eye urgent care setting. BMJ Open Ophthalmol. 2019;4:e000187. Financial interests Rosen: Optovue continued on page 22 the eye are difficult to diagnose the convention- al way," Dr. Rosen said, adding that iScan takes only a minute and provides a firm diagnosis. Urgent OCTs As part of the study, OCT images of 359 eyes were obtained by 25 residents and fellows. Any patient who came into the after-hours clinic complaining of vision loss that was unexplained was included, Dr. Rosen noted. The residents and fellows were surveyed about their experi- ences and how accurate the diagnosis was. "We found that the overwhelming majority thought this was a useful tool to have in this kind of setting and took the care to a much higher level than is typically available," he said. If a patient has swelling and bleeding in the eye, for example, it's obvious that abnormal blood vessels have developed or are blocked, Dr. Rosen said. The retina is transparent, mak- ing it more difficult to see what's going on. "This technology affords high precision in terms of seeing the retina," he said, adding that if you're trained to interpret all the changes that 87-year-old woman complained of painless loss of vision OD; visual acuity = CF for just 6 hours; diagnosis by OCT = CRAO; transferred for emergent treatment with tPA and stroke workup Source: Richard Rosen, MD

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